Laserfiche WebLink
SAN JOAQUIN LOCAL HEALTH DISTRICTFV, Box 106Y <br /> SEPTIC TANK AND CES POOL CLEANERS REPORT ®p lt�rc�j�q 153 <br /> REPORT Ff}R THE MONTH OF�� +�O�SEIBMITTED BY ADDRESS c) _6 7-17 <br /> L I' <br /> NAME OF ADDRESS WHERE GALLONS � <br /> DATE.. 'PROPERTY OWNER �� WORK WAS DONE PUMPED WHERE CLEANINGS WER NLOAD 'DER <br /> t <br /> v <br /> Q 4 <br /> ® O <br /> 1 F: <br /> �I �1 <br /> �Qn Xoct fu 2'n 00 Vt y I certify under penalty of perjury that foregoing is true and correct. <br /> 1 (pC�rL7�mc,,�- DATE ,r; G F PPLIC ANT <br /> 6,00 ifoA-I• —m ac r, 4rt J ro i oo - 500 <br /> 1, <br /> 'x ss 33 l7 V7 <br />